According to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by American Psychiatric Association in May 2013, mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental process underlying mental functioning. Further, the definition of Autism Spectrum Disorder (ASD) can be summarized as the diagnosis given to a wide range of symptoms and severity of neurodevelopmental disorder that impairs an individual's ability to communicate and interact with others. It also includes restricted repetitive behaviors, interests and activities. There is usually significant distress or disability in social or occupational activities.
About 1 in 68 children aged 8 years have been identified with autism spectrum disorder (ASD) based on data collected in 2010 by CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network and published in 2014.
There are no biological tests to diagnose conditions on the ASD. Clinicians and researchers diagnose and classify ASD, based on behavioral symptoms as defined in DSM-5. ASD is a life-long disorder; ASD children grow up into ASD adults. Autism is a heterogeneous disorder; the triggers and therapeutic response for coping are diverse and differ from person to person. About 40% of the children diagnosed with ASD are unable to communicate verbally. ASD boys have been found to be more easily irritable than boys with no psychopathology, and resembling boys with severe mood dysregulation. Several studies have noted higher episodes of elevated anxiety and emotional dysregulation being part of the symptomatology among individuals with ASD.
Also called by other labels such as “socially inappropriate behavior,” “challenging behaviors,” or “autistic ‘meltdowns’,” these are episodes of poorly modulated involuntary emotional outbursts in the ASD individuals that are often intense, frightening, frustrating, and risky. Autistic meltdowns are not goal-related temper tantrums and can be one of the most challenging parts of life for autistic person and his/her caregiver. These challenging behaviors add to the list of barriers to effective education, training, and social development of individuals diagnosed with ASD.
Autistic meltdowns are triggered from being extremely frustrated or stressed, sometimes for reasons that might appear insignificant and hence unexpected to the non-autistic. Causes of autistic meltdowns include, neurological and sensory overload, mounting frustrations over expectations to perform activities and behave within conventional norms, neurological difficulty adjusting to even minor deviations from routine, and failed attempts to be understood.
Autistic meltdowns may be prevented if the accumulating stress levels can be halted and reversed in the antecedent to meltdown phase, called the agitation phase or rumbling phase; referred henceforth herein as pre-meltdown phase. It is a challenge to detect the stress buildup leading to the meltdown phase. The time duration and the intensity of the pre-meltdown phase varies from one ASD person to another, and from one instance to another. Individuals diagnosed with ASD have atypical sensitivity to pain and other stimuli, which also varies from one ASD individual to another. For example, a study had 94% of the ASD individuals sample reporting extreme levels of sensory processing on at least one sensory quadrant of the ADULT/ADOLESCENT SENSORY PROFILE® from NCS PEARSON™, which is a questionnaire assessing levels of sensory processing in everyday life. Limited ability to convey signs or level of discomfort felt, and their early behavioral response to the stress inducing triggers often being subtle to distinguish from their normal behaviors are also challenges faced by the caregivers to timely interpret the early signs of accumulating stress among the ASD.
Upon detection of accumulating stress, mapping the instances of stress to the corresponding triggers would aid the caregiver and allow him or her to intervene and attenuate the triggers, thereby stopping the stress buildup. Further, a timely and specific therapeutic calming intervention, would aid in reducing an autistic person's stress level. The effectiveness of different intervention therapies may vary from person to person due to the high heterogeneity of the ASD individual's sensitivity to different stress triggers. Lateral pressure on the arms and/or torso has been found to comfort some ASD individuals. Music therapy has been documented as useful for calming some ASD individuals. For such individuals, specific comforting sounds could bring down their stress level. Hence, a configurable de-stressing solution to fit the unique needs of the ASD individual is needed.
Due to the above listed challenges, most of the existing methods to capture the causes for the autistic meltdown and dynamically provide timely interventions to prevent an autistic meltdown are often limited to health care or research in laboratories or medical facilities by trained specialists using a variety of distinct tools and methods. There is a need for in situ personalized care to predict and prevent episodes of autistic challenging behaviors.
Other types of disorders, such as epilepsy, can result in serious episodes of seizures or periods of unusual behavior, sensations, and sometimes loss of consciousness. There is a need for in situ personalized care to predict and prevent episodes of challenging behaviors for these conditions as well.